Research

Penny told us not to get too excited too early in labor. That, half the battle is relaxing and giving yourself time to rest during the early parts so that when it gets to the difficult part you haven’t been up for 2 days living on Gu and granola bars and coffee. Because who can do their best work then? But then there’s the uncontrollable excitement, and second guessing, and wondering, When will it start? So I can see how it will be a problem when the time comes, to force rest. To be cool.

What is calming me, today, is this great book that a friend of Esther’s sent us the other day, a signed, uncorrected galley of Anne Lamott’s “Operating Instructions.” I haven’t been very good at reading lately, and only trust myself to finish a book if I don’t put it down for more than a couple hours until it’s done, but this book is pretty amazing. Esther hasn’t read it yet but she send a “Letter to a pregnant friend” by her from about 10 years after the book was written. The whole letter is good, even if some of the advice in it isn’t really totally in line with the home-birth thinking, but that’s okay.

Anyway, read the book. Read the letters. She’s awesome. I also love her other book, Bird by Bird, which is a great book about writing. Of course, it resonates with me that she believes that writing and raising a child require pretty much the same strategies. Ha.

Here’s a poem called “Deteriorata” that she included at the end of the letter:

Gracefully surrender the things of youth:
The birds, clean air, tuna, Taiwan,
And let not the sands of time
Get in your lunch …

You are a fluke
Of the universe.
You have no right to be here.
And whether you can hear it or not
The universe is laughing behind your back.

Therefore, make peace with your god
Whatever you conceive him to be –
Hairy thunderer, or cosmic muffin.

It’s true that drinking during pregnancy is seen as a big taboo, and part of the reason is the lack of information about the causes, risks, and chances of Fetal Alcohol Syndrome along with the rather scary warnings in pregnancy books and on pregnancy websites.

Only 5% of alcoholic mothers give birth to babies who are later diagnosed with FAS.

Drinking alcohol, while a requirement of being diagnosed with FAS, doesn’t seem to cause FAS by itself. Other environmental factors needed include smoking, poverty, malnutrition, high parity (i.e., having lots of children), and advanced maternal age.

There is a genetic component to FAS that makes you more or less susceptible to FAS.

Almost all public health campaigns, whether sponsored by states, social movement organizations, public health institutes, or the associations of alcohol purveyors tell pregnant women not to drink alcohol during, before, or after pregnancy… at all… or else.

Women are being blamed for FAS, even though they do not cause FAS, and neither does drinking alcohol (by itself).

Very few women drink at the levels correlated with FAS, even when they aren’t pregnant.

So, the question is, are the FAS campaigns by all of these organizations merely another way for society to blame women for something bad that might happen? To treat pregnant women as women with some kind of problem that needs to be “fixed” by hospitals, doctors, professional advise, and medication? Why does our society do this to women, and what can we do to help be a little more rational and fair to women and less scared, protective, and controlling?

I read Jenny McCarthy’s Belly Laughs book a couple days ago. Wow. It’s scary to think that she’s encouraging women to act like her, in my opinion.

On the other side of the spectrum, we watched the Business of Being Born last night. That’s a pretty great documentary. I think it was meant to be controversial, and to show the worst of hospitals, and I don’t think all hospitals are as ignorant and backwards as the ones depicted (Seattle’s Swedish, for instance). However, I think the fact that more light should be brought to the midwifery traditions and practices is definitely called for.

According to our midwife, that documentary and the book Pushed have both contributed to a surge in business for midwives in the last few years.

Only 1% of births in the United States are done via midwives, and only a fraction of those are home births. Seattle’s a little different, and actually has between 4-7% of births through midwives. I think it might be because of the better insurance policies that allow them to be covered. So hopefully this number will grow.

One of the great and unexpected things about The Business of Being Born is that the film-maker is pregnant during the making of the movie. Of course, after all this talk about home births and everything, she ends up having pre-term labor and a C-section at a hospital, and had to keep her baby in NICU for 3 weeks.

The reason I think that’s great (in the documentary’s sense, not in the sense that the baby had such a scary beginning) is because every doctor in the movie is like “what if something scary happens?” and this is the answer… you go to the hospital. Hospitals aren’t inherently bad, it’s just that they are designed to deal with emergencies and dangerous medical conditions. Most births, however, are not in this category, and could just as easily (and some argue more safely and nicely) be handled outside of the hospital system. For the 10-15% of births that have complications, it’s awesome that hospitals are there to help, and this fact has a lot to do with the lowering maternal mortality and baby mortality in the last 100 years.

Anyway, it’s just so interesting to think about all of this. I keep trying to remember how we first started down this midwife/home birth track–I remember being just as pro-epidural as the next person before Esther got pregnant. We are trained to be afraid of birth. And, as the non-participatory husband, of course fear is even more justified because all of this is happening to Esther, not me, and therefore the lack of control is scary.

This is merely how I feel now, and reserve the right to change my mind at any point along this pregnancy.

Do people live inside billboards? (there was a sign near our house for the county jail or something, which I was sure was the actual jail itself, and somehow people could be in jail inside a sign… it was weird)

This prenatal test (also called the NT or nuchal fold scan) can help your healthcare practitioner assess your baby’s risk of having Down syndrome (DS) and some other chromosomal abnormalities as well as major congenital heart problems.

The NT test uses ultrasound to measure the clear (translucent) space in the tissue at the back of your developing baby’s neck. Babies with abnormalities tend to accumulate more fluid at the back of their neck during the first trimester, causing this clear space to be larger than average.

The NT scan must be done when you’re between 11 and 14 weeks pregnant. (The last day you can have it done is the day you turn 13 weeks and 6 days pregnant.) It’s usually offered along with a blood test in what’s known as first-trimester combined screening.

Like other screening tests, an NT scan won’t give you a diagnosis. But it can assess your baby’s risk for certain problems and help you decide whether you want to have chorionic villus sampling (CVS) or amniocentesis to find out whether your baby is actually affected.

The NT scan has been performed in the United States since 1995, mostly at large medical centers. Ultrasound technicians (sonographers) and doctors need special training and high-resolution ultrasound equipment to perform it correctly. They must be certified by the Fetal Medicine Foundation in London, the organization that sets the international standards and provides the software that enables a doctor to evaluate your baby’s risk.

I sense that this test is the beginning of many ways that we’ve introduced new ways to worry about pregnancy. The desire to know everything comes from the fear that something scary will happen with the pregnancy. But, strangely, because of the nature of these results, knowing more in many cases only causes you to worry more. Not only that, but doing these tests costs money and also increase the chance of miscarriage.

Another statistic, mentioned in last week’s This American Life, which focused on America’s health care system, is that up to 33% of our medical procedures are not needed. Because we feel like the insurance companies charge us too much, we in turn try to run up our hospital bills with costs to justify the big spending, which in turn makes us a country that spends a lot on health care but isn’t any healthier.

I suspect that the infinite number of blood tests, screenings, etc are a big part of that 33% of things that don’t need to happen. Less is more. By avoiding these tests, I will be saving money (our health insurance has a $3,000 deductible and only covers bills 80% after that, so costs are very real to us), we will be avoiding procedures that increase the risk of problems, and in the meantime we won’t have to worry about ambiguous results and statistics and false reasons to worry.

One recent study, for instance, suggests that a child’s shyness is determined, in part, by maternal hormone fluctuations during gestation. Researchers who interviewed several thousand preschoolers in both the United States and New Zealand noted a significant relationship between the incidence of extreme shyness or inhibition (children who seem particularly fearful, anxious, or withdrawn in the presence of a stranger) and the amount of daylight their mothers were exposed to at midpregnancy. Thus, in the United States, only 12% of children born in October-November-December were rated as highly inhibited, compared to nearly 18% of those born in April-May-June. In New Zealand, where daylight hours are reversed, children showed the opposite pattern, with more shy children born in October-November-December than in April-May-June. Because the production of certain hormones, like melatonin, is known to fluctuate with the amount of daylight in each season, the researchers propose that such substances may subtly alter brain development during a critical period at midgestation, when massive numbers of neurons are migrating to form the basic architecture of the cerebral cortex. (It is also possible that other seasonal differences, like changes in women’s diets, physical activity, or exposure to colds and flu, mediate this relationship.)

Is this when science starts telling us that astrology is true? That would be pretty funny.

I’m about 100 pages into a fascinating book called Pushed. The best way to describe it is as a Fast Food Nation or Omnivore’s Dilemma of the field of obstetrics. The enemy in the book is not necessarily the doctors and physicians, but rather the strange dance between hospitals, insurance companies, and the “malpractice crisis”.

It has turned me from a casual “yeah, it would be nice to avoid an epidural, induction, and Cesarian if possible” to a more emphatic “we should probably try to have the baby outside of the hospital system”.

It doesn’t seem like anyone is really at fault. Everyone is trying to make the business of having babies as safe and efficient as possible, but there are just some pretty glaring conflicts of interest when a doctor needs to pay $900,000/year in malpractice and therefore has to race through births as fast as possible, sacrificing care and patience for fast, risk-adverse, insurance-friendly planned Cesarians.

And then there’s the self-reinforcing loop of wanting to control everything. Inducing a pregnancy that isn’t even to term yet, rather than sending someone back home, for example. The fact that inducing a pregnancy seems to lead to a more painful birth, therefore increasing the need for an epidural. The fact that a failed induction often encourages a Cesarian. All of it could be avoided by simply not going to the hospital until you really need to be there. Or, not going to a hospital at all and having the baby in a birthing center or at home under the care of a licensed midwife.

I’m really coming at this as a complete newbie, so please correct me if I’m incorrect in any of my statements. Esther and I talked about it a bit this morning and think that using the hospital for ultrasounds and all those checkups seems good, and then having the actual baby at a birthing center or under the guidance of a good midwife.

We just need to figure out how much each of these options cost, which things are covered by our minimal maternity insurance, and also talk to our yet-to-be-chosen doctor about some of these things to see where our local hospital is on the spectrum of overly aggressive birthing.